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Home My WebLink AboutBLDE-22-004469 Commonwealth of Official Use Only fi-lAk. Massachusetts Permit No. BLDE-22-004469 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:2/10/2022 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 53 CROWES PURCHASE Owner or Tenant RIVERIN MATHIEU Telephone No. � Owner's Address LAFONTAINE LOUISE,61 CANNON GATE III, NASHUA, NH 03063 RO Is this permit in conjunction with a building permit? Yes 0 No 0 (Check4 Ipr a . Purpose of Building Utility Authorization No. . ;.` si '" Existing Service Amps Volts Overhead 0 Undgrd 0 ``'k,� of'iGLrters"` ,1 . ,'" New Service Amps Volts Overhead 0 Undgrd 0 No. f rr ,ti < Number of Feeders and Ampacity �; Location and Nature of Proposed Electrical Work: Replacement boiler. / '— ,1 ` ,�y \` r Completion of the following table may be c[v t to of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Transformers ..* KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 1 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE:INSURANCE ❑ BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: DANIEL J PECKHAM Licensee: Daniel J Peckham Signature LIC.NO.: 26830 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:87 AUDREYS LN, MARSTONS MLS MA 026481629 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But my signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 Hitt4 7f16-/ v_g / RECER , ED saB 10 2022 `/'� ryryy�jj Commonwealth of///addackuseffd Official Use Only -- = = DEPARTMENT ��` t, !': --- -LJcParfiranf o{ •a Serviced Permit No. ':. BOARD OF FIRE PREVENTION REGULATIONS Occupancy acy and Fee Checked Wt 'ev. 1/07] cave blank All work to be performed in accordance with the Massachusetts Electrical od Lt� �('A` WORK (PLEASE PRINT IN INK OR TYPE ALL INFORp4TION) Date: C),527 CMR l z.00 City or Town of: yARMOUTHo � By this application the undersigned gives notice of his or her intention to performa e electrical work ctor ofdescribed below. Location(Street&Number)�� Owner or Tenant r Owner's Address `v,`' Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No ... ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead New Service ❑ Undgrd❑ No.of Meters Amps _ Volts Overhead Number of Feeders and Ampacity ❑ Undgrd ❑ No,of Meters Location and Nature of Proposed Electrical Work: c tom.. -P.1 ,�, i 6 /t_ Completion o the ollowin-table in- be waived, the Ins.ector o Wires No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total No. of Luminaire Outlets No. Transformers KVA of Hot Tubs Generators KVA No.of Luminaires Above In- `o.o Swimming Pool mergency ,nog _rnd. ❑ =md- ❑ Batte • Units No.of Receptacle Outlets No. of Oil Burners - No.of Switches FIRE ALARMS No.of Zones No.of Gas Burners o.of Detection and No.of Ranges Initiating Devices No.of Air Cond. No.of Alerting Devices No.of Waste Disposers Heat PumpTons Total umber Tons o.of elf-Contain, No.of Dishwashers Space/Area Heating DetectioNN e n Devices a No.of Dryers Local❑Connection ❑ Other Heating Appliances , Security Systems:* INo.of ater No.of Devices or E.uivalent `- Heaters KW No, o o.of Si• s Ballasts Data Wiring: No. Hydromassage Bathtubs No.of Devices or E,uivalent No.of Motors Total HP Telecommunications Wiring: �! OTHER: No.of Devices or E,uivalent Estimated Value of Electrical Work Attach additional detail c desire f d or as required by the Inspector of Wires. Work to Start: (When required by municipal policy.) p INSURANCE Inspections to be requested in accordance with MEC Rule 10,and upon completion. % CE COVERAGE: Unless waived by the owner,no permit for the performance the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent undersigned certifies that such coverage is in force,and has exhibited proof of same of electrical work may issue unless CHECK ONE: Ifies that q rvalent. The 1' , to the permit issuing office. BOND I certlfy, under the pains ancC penalties ❑ OTHER ❑ (Specify.) `�' FIRM NAME: fpe fury,that the information on this application is true and complete. Licensee: � _ LIC.NO.: �, (If applicable enter "exempt"in the license number Signature � //� —�_ Address: le. LIC.NO.: _ f� B"`� �'► Bus.Tel.No.- . J Per M.G.L. c. 147 s.57-61,security 1�ro- tit fL� ""' c. No. OWNER'S INSURANCE h work requires Department of Public Safe Aft.Tel.No.:. T RANCE WAIVER: I am aware that the Licensee does not havethe liability insurnse: ance coverage n— or l� required by law. By my signature below, hereby Owner/Agent by I waive this requirement I am the(check oneoy Signature 0 der 0 owner's a enL Telephone No. PERMIT PPP. c